holodent

Article très intéressant.
Effectivement pour me soigner une carie, mon dentiste a essayé de trouver la meilleure solution sachant que je suis MCS (hypersensible chimique). La céramique selon lui étant le matériaux le plus inoffensif mais c'était sans compter les effets de la colle, donc j'ai été malade. Après il a essayé un pansement temporaire (je crois en ciment) mais je ne l'ai pas supporté non plus.
Visiblement vous ne conseillez pas le titane, alors qu'en serait-il de l'or ?
J'apprécierais beaucoup si vous pouviez me conseiller sur la question.
Yolande

j'entends bien mais ayant une très mauvaise dentition nécéssitant la pose de nombreuses couronnes pour la vice qui doit être introduite dans la racine (inlay core , je crois?)que dois-je demander à mon dentiste?
Merci d'avance pour vos conseils.
cordialement.

Bonjour,

Après avoir parcouru la page sur les amalgames dentaires, je pense que vous devez être informés d'une chose.

Je tiens à signaler que je suis dentiste. Je pose des amalgames et des résines composites.

Certes, les amalgames dentaires relarguent du mercure, mais ce que vous semblez ignorer, comme la majorité (dentistes compris), c'est que les résines composites, relarguent elles-aussi des composés toxiques.

En effet, ces résines durcissent par réaction de polymérisation. Or, lorsqu'elles ne sont pas entièrement polymérisées (ce qui est le cas quand elles sont montées et collées directement en bouche en une seule étape, mais pas quand elles sont montées en laboratoire de prothèse puis collées en bouche), relarguent tout un tas de choses pas très clean.
En voici une liste non exhaustive : Bis-GMA, TEGDMA, Bis-EMA, UDMA... Ce sont des molécules monomères qui sont allergisantes, cytotoxiques, cancérigènes, avec des effets sur les réactions immunitaires locales.
De plus, quand elles vieillissent, les résines composites se dégradent et relarguent entre autres du bisphénol A (le fameux !) et du formol.
J'aimerais que ces informations soient AUTANT MEDIATISEES que le fait que les amalgames dentaires relarguent du mercure, du cuivre, de l'étain, de l'argent et divers alliages issus du mélange de ces différents métaux.
Cela forcerait la profession à une énorme remise en question sur la dangerosité des produits que nous mettons tous les jours dans la bouche des gens, question qui me taraude depuis que j'ai pris conscience en de la composition de ces produits.
Cela donnerait aussi un grand coup de pied dans la fourmilière et permettrait d'empêcher le "lobby" des vendeurs de résines composites de dormir sur ses deux oreilles.

Par ailleurs, il faut savoir les résines composites sont très sensibles à l'humidité. Leur manipulation doit suivre un protocole très rigoureux (beaucoup plus rigoureux que celui des amalgames dentaires). En France, elles sont souvent mal utilisées car apparues assez récemment, beaucoup de dentistes n'ont jamais appris à les manipuler, si ce n'est par les commerciaux qui les leur vendent. Et comme nos confrères ne jugent souvent pas utile d'assister à des formations continues leur permettant de maîtriser les protocoles opératoires, ces résines mal utilisées relarguent donc d'autant plus de matériaux non polymérisés. Par ailleurs, quand elles sont mal utilisées, elles entraînent énormément de récidive de carie, simplement du fait qu'elles sont mal collées et donc non étanches. Alors que les amalgames dentaires eux, sont plutôt anti-bactériens et ont tendance à éviter les récidives de caries, même lorsqu'ils sont mal utilisés. Il n'y a donc pas qu'une question de santé générale, mais aussi une question de santé dentaire.

Je ne sais pas où vous avez fait vos études et de quand elles datent, mais on ne m'a jamais enseigné que le monomère est toxique pour la pulpe. On m'a par contre enseigné "qu'avant on le croyait toxique pour la pulpe, mais qu'il s'avère que c'est le manque d'étanchéité que est toxique".
je mets en fin de message quelques références glanées sur pubmed.
D'autre part, je ne remets absolument pas en cause la dangerosité des amalgames. Je veux juste qu'on sache que les composites ne sont pas anodins pour l'organisme.


1. Clin Oral Investig. 2010 Apr 20. [Epub ahead of print]

Proliferation of rat molar pulp cells after direct pulp capping with dentine
adhesive and calcium hydroxide.

Dammaschke T, Stratmann U, Fischer RJ, Sagheri D, Schäfer E.

Department of Operative Dentistry, Westphalian Wilhelms-University, Poliklinik
für Zahnerhaltung, Waldeyerstr. 30, 48149, Münster, Germany,
tillda@uni-muenster.de.

The aim was to evaluate the proliferation of pulp cells 1, 3 and 7 days after
direct pulp capping with the dentine adhesive Gluma Comfort Bond (GCB) and to
compare it with calcium hydroxide (Ca(OH)(2)). An occlusal cavity was prepared in
72 molar teeth of 36 Wistar rats. Then GCB or Ca(OH)(2) was placed on the exposed
pulp. All cavities were restored with composite. After 1, 3 and 7 days, the
animals were sacrificed. One hour prior sacrification, 5-bromo-2'-desoxyuridine
(BrdU) was injected into the intraperitoneal cavity for immunohistological
analysis of 18 animals. BrdU was incorporated into the DNA to tag proliferating
cells using an antibody staining. Three animals served as controls and were not
further treated. The number of the tagged cells was statistically analysed by
comparing the results of the three groups. In 18 rats, routine histological
analysis was performed in order to evaluate the pulp tissue for bacterial
infection, inflammatory cells and necrosis. The marked cells were identified as
fibroblasts, endothelial cells (after 1, 3 and 7 days) and Höhl cells (after 7
days). One day after capping, significantly more cells were stained in the GCB
than in the Ca(OH)(2) group (p < 0.05). After 3 days, significantly more cells
were stained in the GCB than in the Ca(OH)(2) and the control group (p < 0.016).
Direct contact of GCB with pulp tissue leads to an increased formation of
granulation tissue (fibroblasts, endothelial cells) because of an inflammatory
reaction. This may be explained by missing antibacterial effect and foreign body
reactions. Also, GCB may have a negative effect on Höhl cells.

PMID: 20405184 [PubMed - as supplied by publisher]


2. Dent Mater J. 2010 Jan;29(1):15-24.

Observation of calcium phosphate powder mixed with an adhesive monomer
experimentally developed for direct pulp capping and as a bonding agent.

Katoh Y, Suzuki M, Kato C, Shinkai K, Ogawa M, Yamauchi J.

Department of Operative Dentistry, School of Life Dentistry at Niigata, The
Nippon Dental University, Chuo-ku, Niigata, Japan. yoshirok@ngt.ndu.ac.jp

In this study, morphological shape, elemental distribution and elution properties
of Ca, P, Mg in four types of calcium phosphate powder were investigated using
SEM, EPMA and ICP-AES. Calcium phosphate powder: OHAp, DCPD, beta-TCP and OCP
were observed in the white powder form and in the photopolymerized adhesive
monomer they scattered like dispersed fillers in resin composite. In elemental
analysis, CaKalpha showed a relatively high concentration in relation to PKalpha.
In elution analysis, each calcium phosphate showed different elution of Ca and P.
But Mg was almost equal to the detection limit of ICP-AES. Namely it was
suggested that reparative dentin formation was effectively promoted under the
following conditions: a calcification promoting effect by direct contact of the
calcium phosphate powder, an ionic effect of Ca and P eluted from the powder
located in the vicinity of the exposed pulp and environmental pH change of the
surface in exposed pulp.

PMID: 20379007 [PubMed - indexed for MEDLINE]


3. Quintessence Int. 2009 Jun;40(6):e26-34.

The adverse effect of self-etching adhesive systems on dental pulp after direct
pulp capping.

Cui C, Zhou X, Chen X, Fan M, Bian Z, Chen Z.

Center of Stomatology, Tongji Hospital of Tongji Medical College of Huazhong
University of Science & Technology, Wuhan, People's Republic of China.

OBJECTIVES: To evaluate the histopathological changes in mechanically exposed dog
pulps capped with three self-etching adhesive systems. MATERIAL AND METHODS:
Seventy-two Class V cavities were prepared under rubber dam isolation in dogs.
The pulps were exposed and capped with Clearfil SE Bond (Kuraray), Imperva
FluoroBond (Shofu), Prompt L-Pop (3M ESPE), and Dycal (Dentsply; control capping
agent), respectively. Histopathological examination of the teeth was performed at
7, 14, and 30 days postoperatively. Hematoxylin-eosin staining was performed to
assess the inflammatory cell response, tissue disorganization, and hard tissue
formation. Brown and Brenn staining was used to detect the presence of bacteria.
The data were analyzed by Kruskal-Wallis and Nemenyi tests. RESULTS: Most pulps
showed moderate to severe inflammatory responses. Hard tissue formation appeared
at 14 to 30 days. Positive bacterial staining was observed in most specimens in
experimental groups. The histological changes in the pulps of the experimental
groups were more pronounced than in the control group. Differences in
inflammatory response, tissue disorganization, and hard tissue formation were
observed among teeth treated with the three self-etching systems. CONCLUSION:
Microleakage has a critical influence on pulpal repair. It is not beneficial to
cap the pulp with self-etching adhesive systems. Diverse pulpal responses were
observed to the self-etching adhesive systems, and the histological changes were
more pronounced than in the control pulps treated with Dycal. The effects of the
self-etching adhesive systems are such that these materials require further study
to address issues of bacterial microleakage during placement of restorations.

PMID: 19587881 [PubMed - indexed for MEDLINE]


4. Stomatologiia (Mosk). 2008;87(4):11-3.

[Biocompatibility study of some adhesive systems for tooth pulp indirect and
direct capping]

[Article in Russian]

Faĭzullaeva NN, Vinnichenko IuA.

Microcolorimetric method was used for study of toxic and antiproliferous
properties of 3 adhesive systems acting by adhesive upon fibroblast cell culture.
It was established that I Bond adhesive system was most biocompatible and that it
can be used for direct and indirect capping of injured tooth pulp.

PMID: 18833130 [PubMed - indexed for MEDLINE]


5. Int Endod J. 2008 Aug;41(8):643-50. Epub 2008 Jun 28.

Histological evaluation of direct pulp capping with a self-etching adhesive and
calcium hydroxide on human pulp tissue.

Lu Y, Liu T, Li H, Pi G.

Endodontic Department, Beijing Hospital of Stomatology, Capital University of
Medical Science, Beijing, China.

AIM: To evaluate human pulp tissue response following direct pulp capping with a
self-etching adhesive: Clearfil SE BOND (SB). METHODOLOGY: Forty-five sound teeth
from 20 subjects were used. Forty-one teeth had their pulp mechanically exposed
at the base of a Class 1 cavity preparation and were divided into two groups:
group 1, teeth were capped with SB (n = 21), and group 2, with calcium hydroxide
cement (CH) (n = 20). Four teeth were maintained intact as an untreated control
group. After 7, 30 and 90 days, respectively, 15 teeth were extracted and
processed for light microscopic examination. Pulp healing and bacterial
microleakage were assessed by haematoxylin and eosin, Masson trichrome and Brown
and Brenn stain techniques. The data were analysed statistically by using the
Mann-Whitney U test. RESULTS: After the 7-day observation period, the
inflammatory reaction in the SB group was slight and significantly less severe
than that of the CH group (P < 0.05). After the 30- and 90-day observation
periods, the inflammatory reaction was slight in both groups, but specimens with
dentine bridge formation in the SB group were significantly less common than
those in the CH group (P < 0.05). CONCLUSIONS: Clearfil SB had good
biocompatibility with human pulp tissue, but its ability to induce reparative
dentine was significantly lower than that of calcium hydroxide.

PMID: 18554189 [PubMed - indexed for MEDLINE]


6. Am J Dent. 2007 Jun;20(3):182-8.

Clinical and radiographic evaluation of adhesive pulp capping in primary molars
following hemostasis with 1.25% sodium hypochlorite: 2-year results.

Demir T, Cehreli ZC.

Department of Pediatric Dentistry, Hacettepe University, Ankara, Turkey.

PURPOSE: To evaluate, prospectively, the clinical and radiological response of
primary molars, pulp-capped with calcium hydroxide and different adhesive systems
after hemorrhage control with 1.25% sodium hypochlorite (NaOCl). METHODS: 100
primary molar teeth